Monday, November 24, 2008

Thomas Joiner provides a robust descriptive model of suicide, but repeatedly refuses to consider the deeper "why" - the answer to which might be evolutionary adaptation in the Pleistocene.

In bathrooms at Disneyland,
signs
over the sinks offer what are described as "hand washing tips." The alleged "tips" are:

Wet hands and apply soap.

Scrub hands and rinse.

Dry hands thoroughly using paper towels.

People find this sign amusing from an epistemological standpoint: it's not so much a set of
hand washing tips
as it is a (humorously unnecessary) phenomenological description
of the act of hand washing. It is funny because it purports to have normative content, but fails to contain anything but description.

Similarly, Thomas Joiner's
Why People Die By Suicide
promises, in its title and its project, to provide an explanatory model for suicide. Joiner does provide a useful descriptive
model of suicide, but he fails to live up to his title's promise of an explanation
of suicide. In fact, he explicitly rejects, on what are essentially aesthetic grounds, the most promising candidate for a genuine explanatory model of suicide - that is, evolutionary psychology.

Joiner's Model

According to Joiner, three factors cause suicide: competence, or the ability to carry out a suicide; the feeling of being a burden; and social failure to belong. The first factor, competence, includes the physical ability, knowledge, and pain tolerance required to carry out a suicide, as well having lost or overcome the fear of death. The second and third factors, burdensomeness and failed belonging, join together to create the desire for death. Both the desire for death and the capability to achieve death must coexist in order for a person to commit suicide; that much is obvious. Joiner's main contributions are setting this up in a clear formulation, and positing the two specific factors that constitute the desire for death.

Importantly, while maintaining that mental illness is relevant to suicide, Joiner does not implicate mental illness in
causing
suicide - rather, his model explains the elevated suicide levels in people with disorders like Bipolar I and II and Borderline Personality Disorder by the fact that such disorders (a) facilitate comfort with increasingly lethal self-harm, (b) increase feelings of (and perhaps actual) burdensomeness, and (c) decrease the ability to belong.

Joiner's model is clear, helpful, and well-supported by studies. The problem with Joiner's model is that, while it describes who commits suicide and how they manage to do it, it fails to explain
why
those people commit suicide. Why should people care about being a burden to others? Why should people care about social belonging? Why should they care about these things, but not other things, enough that death is preferable to the pain
of burdensomeness and thwarted belonging?

Joiner is comfortable providing an answer as to why it should be difficult to commit suicide, and why the first element of his model, competence, should be necessary: natural selection. He implicates specific genes and brain traits in suicidality (even distinct from the genetic contribution to mental illness). Yet he explicitly refuses to consider the possible role of natural selection in regard to the other elements of his model, or to suicide as a phenomenon.

Why should people care about whether they are burdens on other people? Why isn't it, say, the feeling of being
overburdened by others
that causes suicide? And why should failure to belong be so painful as to facilitate suicide? Why not anger, or guilt, or physical pain, or even excessive social contact? Joiner makes no attempt to explain. But an adaptive model readily explains the features of Joiner's model, in addition to clarifying Joiner's more questionable results; indeed, the adaptive model has more explanatory power than Joiner's model.

Failure to Consider Suicide as an Adaptive Behavior

Suicide, like filicide, seems upon first consideration to be a ludicrous act, viewed from the perspective of evolutionary biology: how can one's genes go on if one kills oneself or one's child? However, the act of filicide (the killing of one's child or children) is clearly adaptive in many cases. Not only that, but it can be shown through statistical evidence that actors seem to differentiate between adaptive and non-adaptive filicides when they "decide" to commit
filicide
(as well as other apparently fitness-threatening homicides, like uxoricide
and siblicide). What about suicide?

An act is adaptive when it increases the
inclusive fitness
of an actor - that is, when the act's benefits - in terms of survival, procreation, or nepotistic distribution of resources to one's genetic relatives - exceed the act's costs, in the same terms.[1]

Under certain conditions, one's expected contribution to one's own genetic fitness (likelihood of reproduction, likelihood of the survival of one's future offspring to reproduce, effectiveness at materially supporting one's offspring and other relatives) may fall to virtually nothing. However, as long as one survives under these circumstances, he not only contributes nothing to his own genetic fitness, but also likely
drains
the resources of his genetic relatives. His continued survival is contrary to his genetic interests. Therefore, suicide, in this limited situation, must be said to be adaptive. (For my earlier thinking on this topic, see my essay,
The Evolutionary Biology of Suicide: Is Suicide Adaptive?)

It would be callous and cruel to think of a sick relative as a
burden
who would be better off dead. And that is not the message of an inclusive fitness model - its message is merely that, in the Pleistocene era when modern humans were evolving, a heritable trait that functioned to tell a human something like "die if you're a net burden on your genetic kin, otherwise stay alive" may have carried benefits in terms of selection. However, Joiner cannot get past the (admittedly substantial) emotional load of the adaptive model of suicide, and rejects it on what are essentially aesthetic grounds:

. . . I do not much like this adaptive suicide view; my own dad died by suicide and the idea that he was an actual burden is offensive. My view is that self-sacrifice is adaptive in some animal species. It may have been adaptive under certain conditions in the course of human evolution, but we will never really know. Most important, it does not really matter now. What matters now is that perceived burdensomeness - and, to the extent that it exists, actual burdensomeness - are remediable through perception- and skill-based psychotherapies. Death is no longer adaptive, if it ever was. [Joiner, p. 115]

This is a strange statement for a scientist. Although Joiner is writing a book called
Why People Die By Suicide, he asserts that the essential "why" of his research
does not matter
- especially to the extent that it might be "offensive." In this, I think he misunderstands the nature of the adaptive view. It is not to say that suicide is good or bad, or that Joiner's dad really
was a burden to Joiner or his family - simply that, in the human environment of evolutionary adaptedness, the ability and predilection to commit suicide under certain conditions may have conferred a benefit. Joiner also wrongly asserts that "we will never really know" about the adaptive theory, when he should know that the evolutionary psychology model is perfectly capable of generating testable hypotheses, and has done so in the past with robust results.

Joiner pushes the notion that it is
perceived
burdensomeness - not actual
burdensomeness - that facilitates suicide. However, this may be more nice than true: suicidal persons' perceptions of their own burdensomeness may in fact be highly accurate. Just before he dismisses the adaptive theory of suicide, Joiner summarizes a study supporting the view that suicides really are a burden: "when researchers interviewed the significant others of eighty-one people who had recently attempted suicide, a majority of significant others reported that their support of the patient represented a burden to them."

The adaptive model leads to different predictions (and, in turn, possibly different risk assessments and treatment models) from Joiner's model. For instance, in Joiner's model, "belongingness" is all that matters. But an adaptive model would predict that some forms of belongingness would be more protective against suicide than others - specifically, contributing to the welfare of one's genetic relatives (or, perhaps, surrogates for genetic relatives) would be more protective than other forms of belonging. Relationships with spouses and children would matter more than relationships with friends in an adaptive model, but not in Joiner's model. Joiner does not even consider this to be a question worth researching. Similarly, in Joiner's model, all that matters is "burdensomeness" - no matter who is burdened. An adaptive model might predict that burdensomeness on genetic relatives in particular (or their surrogates) would trigger suicidal behavior, rather than burdensomeness on non-relatives. Again, Joiner is not interested in testing this hypothesis, although it might have major implications for treatment and risk assessment. It cannot be said, with regard to the adaptive view of suicide, that "it does not matter now."[2]

Joiner's model, including a refusal to consider the adaptive view, seems to strain when it encounters certain data. For instance, when explaining the data that pregnant women experience a lower suicide rate than non-pregnant women - one-third the non-pregnant rate in one study - Joiner says: "I would suggest that the protective influence involved feelings of connection to the baby, as well as feeling needed by the baby and thus not a burden." But a relationship to an unborn, unseen person who cannot respond is a strange sort of "relationship." An adaptive explanation - pregnancy confers clear survival value compared to non-pregnancy - is less strained than a belongingness/burdensomeness model, and, in fact, provides a deeper explanation of
why
a pregnant woman might develop deep feelings for a non-speaking person inhabiting her body.[3]

Joiner's model accounts for sex differences between the suicide rates of men and women in two ways: first, in terms of competence, men are more likely to be exposed to provocative stimulation (all kinds of violence and more) that break down one's fear of death over time; second, in terms of desire for death, men are more likely to be disconnected and more likely to feel they are burdens than women. This is probably true - the first part, in particular, accords well with
what I believe to be the most accurate explanation
for the differences between the suicide rates of men and women - but, again, why should this be? Why should men be more prone to risky, painful, violent, or as Joiner terms it, "provocative" behavior?

The answer, again, lies in evolutionary biology. Men are not merely "socialized" to be more violent - there are good evolutionary reasons for their greater violence and risk-taking in all areas. A great deal of this is due to what Daly & Wilson term the "effective polygyny" of human beings (at least in the EEA) - that is, that the fertility variance among men is much higher than among women, with many more men than women having a high number of children, and, similarly, many more men than women having
zero
children. This leads to the sad phenomenon of male disposability
- while a woman is "valuable," with a certain, nearly guaranteed level of reproductive success, a man may have no reproductive success at all - but may, by engaging in risky behavior (e.g., successful killing in wars or honor battles), increase his reproductive success to well beyond what a woman might have. A human male is, sadly, invited by his genetic heritage to gamble his life on the chance of a big payoff in reproductive success.[4]
What is driving differential violence in general may also drive differential suicides - even independently from the greater access to fear-reducing, provocative experiences.

More specifically, Joiner's model does not explain why, in addition to varying between genders and across age groups, the time pattern in suicides across age groups is different between men and women. Men's suicide rates are a linear function of age: the older the male, the higher the suicide rate. Women's suicide rates vary with time differently, however. While in some countries, the pattern for women matches that for men, in other countries the pattern is very different. In Canada, rather than rising linearly with age, suicide among women peaks during the 35-44 age range; in the United States, the Netherlands, and Sweden, it peaks during the 45-54 age range; and in Australia, Denmark, and Poland, female suicides peak in the 55-64 age range.[5]
While belonging and burdensomeness are probably implicated, the fact that these are the age ranges of menopause and post-menopause in women seems to lend support to the adaptive view as to why
burdensomeness and thwarted belonging would come into play at those times.

While Joiner's model is compelling, I think there is persuasive evidence that an adaptive model explains suicide better than Joiner's model.[6]
At the very least, such a hypothesis deserves to be considered, and should not be rejected on merely aesthetic grounds. To do so is irresponsible and unscientific. An accurate analysis of the etiology of suicide affects both assessment of the risk of suicide and treatment for the suffering that causes suicide.

Joiner refuses to consider whether a successful, completed suicide may be adaptive. Elsewhere, he refuses to consider data suggesting that making an apparently lethal but ultimately
unsuccessful
suicide attempt may be not only adaptive, but economically beneficial - provided one does not die in the attempt. In a 2003 article in the Southern Economic Journal, Dave Marcotte presented data that suicide attempters experience an increase in income after the attempt that is proportional to the lethality of the attempt. Charles Duhigg summarizes in his
Slate
article, provocatively subtitled "Why trying to kill yourself may be a smart business decision":

Marcotte's study found that after people attempt suicide and fail, their incomes increase by an average of 20.6 percent compared to peers who seriously contemplate suicide but never make an attempt. In fact, the more serious the attempt, the larger the boost — "hard-suicide" attempts, in which luck is the only reason the attempts fail, are associated with a 36.3 percent increase in income. (The presence of nonattempters as a control group suggests the suicide effort is the root cause of the boost.)

Marcotte's data suggests that a suicide attempt, particularly an apparently lethal one, acts as a signal that the individual needs help - and, as it is a signal that entails significant cost (the risk of death), it is a particularly believable signal. This signal seems to act to make resources "cheaper" - a suicide attempter may get access to resources that he did not have access to before the attempt.

Again, Joiner is having none of it, and again, it's for aesthetic, not scientific, reasons. Joiner's complaints are two: the economic "viewpoint" is dangerous, in that it may encourage lethal-seeming suicide attempts; and it is callous, in that it denies the reality of the suffering experienced by the suicidal individual. Both of these "complaints" are without merit and are, I think, evidence of shoddy thinking on Joiner's part.

As to the "danger" of the economic model, Joiner says

The danger of viewpoints like this should be pointed out. Any analysis that encourages suicidal behavior in any way - particularly in ways that romanticize or glorify it, or make it seem easy and normative - has potential negative consequences for public health.

But it is hardly the
viewpoint
that is dangerous - it's the existing incentive structure in our society that encourages apparently lethal suicide attempts in people who often don't really want to die. I have argued that if the suicide prohibition were ended, this dangerous incentive structure
- the "fantasy of rescue" - would also end. (I have also proposed an outline of a model
for ending the prohibition on suicide, with particular attention to ending the dangerous fantasy of rescue.) Analyses are not dangerous. Problems
are dangerous; analyses identify the problems and point the way to solutions. By suggesting that the economic analysis is dangerous, Joiner is contributing to the taboo against speaking about suicide.[7]

Joiner's idea that the economic hypothesis denies the reality of the suffering of suicide attempters is even more ridiculous. He believes that the economic idea is part of some kind of "deconstructionist" philosophy - he actually mentions Jacques Derrida by name (not kidding): "What is left for the deconstructionist, then, is a constant questioning of the very existence of reality and meaning - including the reality of emotional pain. Try telling that to a suicidal person."

This objection makes so little sense that I had to reread the section (pp. 43-44) a couple of times before I understood it.[8]
Joiner thinks that the economic model does not account for the pain suffered by those who attempt suicide. But the economic model suggests no such thing! Despite Duhigg's unfortunate opening example
in his popular reporting of the Marcotte study, the hypothesis is not
that people coldly calculate that they will get a benefit from an apparently lethal suicide attempt. Rather, suffering people are motivated by that awful, extremely real suffering to do something awful - to, essentially, gamble their lives on a chance at making the suffering stop.

Culture, Language, and Occam's Razor

One of the anomalies that Joiner believes he can explain with his theory is the fact that, while, in general, men commit suicide at a much greater rate than women, women in China commit suicide at a greater rate than men. Joiner is quick to find a cultural culprit: Confucianism. Specifically, he says that "the role of Confucianism in Chinese society and its view of the inferior position of women has been emphasized as one explanation, one that is consistent with the current emphasis on effectiveness as a buffer against suicide. (p. 157)" Social scientists, particularly white, Southern social scientists[9], are often quick to reach for a complicated but distancing cultural explanation when there is a perfectly good, but uncomfortable, solution available that might actually survive Occam's Razor.

In the case of female suicides in China - and higher comparative rates of female suicide throughout Asia, including India (a noted hotbed of Confucianism) - the uncomfortable but obvious explanation is that lethal poisons are available in Asia, but not in the United States. Most females who commit suicide in China
do so by poison, and the pattern holds true in other areas where female suicides exceed those of males,
such as Bangalore, India. In the United States, many people, including females, attempt suicide by poisoning, but few succeed - lethal poisons are just not available in the United States, and in the event of a potentially lethal poisoning, medical care is not only available, but compulsory. The medical care necessary to treat a poisoning is often not available in China, especially in rural areas.

According to Joiner's own model, females, who are exposed to less violent, provocative stimulation than men, should have less capability to commit suicide - by
violent
means. However, death by overdose or poisoning is not violent and is within the capabilities of many women. One need not reach for what even Joiner admits is speculation - that Chinese women, since they perform well in sport competitions (is he thinking of the Olympics?), are, as a group, encouraged to engage in athletics, leading to the development of more masculine traits, such as violence. Joiner's explanation is, indeed, speculation, and ignores an obvious explanation that is consistent with his model. Perhaps the poison explanation is not as satisfying to Joiner as speculation about the effects of athleticism, because it fails to portray Asian people as sufficiently different
from whites.[10]

Joiner indulges in even less responsible speculation when he considers language. Joiner devotes considerable time to the hypothesis that suicidal people fuse themes of life and death - that death becomes a focus for belonging and effectiveness. In contrast to the rest of his book, in which peer-reviewed studies are frequently cited as evidence for his claims, his main evidence for the "fusing of life and death themes" hypothesis is Nirvana lyrics (though he does give us a few isolated quotations of suicidal people that, if you squint the right way, seem to back up his idea).[11]
I think that Joiner likes the idea that suicidal people fuse themes of life and death because it makes us seem more psychotic, and less rational in our actions.

The Ethics of Suicide and the Reality of Suffering

Though Joiner clearly has an ethical opinion (suicide is bad), he devotes no time to the question of the ethics of suicide and of forced hospitalization and the suicide prohibition in general. This is not unexpected. It is considered polite and compassionate to do "what is best" for suicidal people, and it is considered to be a serious failure of compassion to suggest that some of us might just know what is best for ourselves. To question suicide prevention on ethical grounds would be extremely foreign to Joiner's way of thinking.

In addition, Joiner is
sure
that every
death by suicide is preventable because treatment is available, but he fails to cite studies of treatments for suicidal misery that have a 100% long-term success rate. Instead, he proposes, in addition to the usual coercive suicide prevention techniques, public service announcements that say "keep your friends and make new ones too - it's strong medicine." He thinks that if more people called a friend every day, just to chat for a few minutes, there would be fewer suicides. He does not seem to apply this thinking to the suicide of his own father, however. His father, at the time of his death, was receiving what Joiner terms "reasonable treatments" (a mood stabilizer and an SSRI), but "his treatment came too late." Joiner notes that his father sought out friends toward the end of his life, as Joiner's patronizing public service announcement would have advised him, but "his efforts were not sufficient . . . . These things were beyond him . . . . (p. 226)"

Based on his (undefended) position that suicide is wrong, Joiner repeatedly describes websites like
ASBS
(an incarnation of the usenet group alt.suicide.holiday.bus.stop) as "pernicious" (God knows what he would think of my
project). He wrongly and tellingly characterizes ASBS as pro-suicide - ASBS is pro-choice, as am I. He approvingly cites restrictive guidelines for news outlets regarding reporting on suicides. Joiner says he is against lying about suicide, and is in favor of removing its stigma, but he doesn't want conversations about suicide to occur if he doesn't approve of their content.

Joiner promises an explanatory model - he calls his book "a comprehensive theory of suicidal behavior (p. 222)" - and makes assertions based on tacit moral assumptions. I think that Joiner owes us not only an explanation of why people die by suicide, but also of why dying by suicide is wrong - and why coercive means of suicide prevention are ethically appropriate.

Notes

1.
Of course,
traits
are heritable, not acts, but the
ability and predilection
to commit certain acts, and the ability to distinguish
when to do so and when not to do so, may be seen as traits to the extent that they are specifically heritable. More precisely, we must say that a trait
is beneficial when it increases one's inclusive fitness. A trait may be very specific.

2.
There is one sense in which it really
doesn't
matter, of course, and that is the ethical
sense. In fact, this is the sense in which even I have previously stated
that an adaptive model makes no difference. But this is not the sense in which Joiner means it. He means that it can have no assessment or treatment consequences and that it is not an appropriate topic for scientific inquiry. As I stated above, the adaptive model has clear assessment and treatment implications. Whether the adaptive model is supported or refuted, it does
matter.

3.
Another set of data must be explained - a group of "initially pessimistic" teenage mothers reported low depression while pregnant, but high depression postpartum. Joiner attributes this to "the belief that connection to the baby and the baby's father would solve ongoing problems" during the pregnancy, and to the fact that "the idea that motherhood would solve ongoing problems was not confirmed" after birth. However, the adaptive model gives a cleaner explanation: it makes evolutionary sense for the chemical changes during pregnancy to promote positivity and effectiveness, but also for the fitness prospects of the new baby to be evaluated coldly once the baby is born. This is particularly true for a young mother with no mate. This view is supported by
Martin Daly and Margo Wilson's work on infanticide.

8.
I suspect that Joiner has limited familiarity with economic models and economic thinking, which may be why he seems even more threatened by this idea than by the idea that suicide is adaptive.

9.
I don't think this characterization and its implications are unwarranted. Joiner reports two incidents of people doing crazy things that might inure them to the pain of suicide. In one, a man Joiner specifically identifies by name, Huyn Ngoc Son, "swallowed three metal construction rods, each around seven inches long," on a bet from drinking buddies, and had to have them surgically removed. In the other story, a man in England, whose name Joiner does not mention, drank fifteen pints of beer, had an argument, and went home to get a shotgun - which, while he was carrying it back to the bar in his pants, discharged shotgun pellets into his "groin area," potentially rendering him infertile.
Research reveals
that the man's name in the second incident was David Walker - the non-Vietnamese name was apparently not funny and foreign-sounding enough for Joiner to include in his description of the event.

10.
I know that's not warranted, but I have as much evidence for that claim as Joiner does for his claim that Chinese women are "sportier." Also, I am an Internet crackpot, and Thomas Joiner is a goddamn principal investigator.

11.
Elsewhere, Joiner reports that he did a "social word" analysis of a suicidal and a non-suicidal Faulkner character - yes,
characters from literature
- and found that, indeed, the suicidal character used fewer social words. "Faulkner accurately portrayed relatively poorly understood, intense, and rare psychological processes - still more indication of his literary genius." This is a fun stunt, but the fact that Joiner thinks it belongs in a section called "Research on Social Isolation, Disconnection, and Suicidal Behavior" calls his judgment and intellectual honesty into question.

19 comments:

"According to Joiner, three factors cause suicide: competence, or the ability to carry out a suicide; the feeling of being a burden; and social failure to belong."

Is this really so? Don't people kill themselves for other reasons too, like heartbreak, agonizing illness, a sense of meaninglessness, and so forth? It seems to me that factor number two,
the feeling of being a burden, will only be a factor in some but not all suicides, and that factor number three,
social failure to belong, comes very close to being a negative "cause", and perhaps just a statement of the author's favorite suicide preventative, namely, involvement in the affairs of other human beings, which can without a doubt be a great distractor from those affairs which are genuinely one's own.

Mitchell, actually the man has studies to back his claims up - in studies that control for everything imaginable (Joiner uses the term "Kitchen Sink" in one of his studies), "burdensomeness" is one of the few things that doesn't disappear. In one study, it's the only thing (even including mental illness). I think it's possible that other things sometimes cause suicide, but he does seem to have a strong model just with his three factors. Not all kinds of pain seem to lead to suicide.

I think his emphasis is wrong, though - he'd attribute someone killing himself over a relationship ending to "failed belonging," where I see sexual-relationship-"belonging" to be a special thing with special evo-bio implicatons.

TGGP, I usually try to leave out the personal stuff, but in my case it's more of a negative reason - lack of reason to live, you might say. Life has its pains, though mine are certainly less painful than most - I'm relatively privileged, I have perfect love and meaningful work, but it is my firm conviction that none of the sweet things in life
make up
for the ordinary awfulness we must all experience as a necessary part of getting up in the morning. Suffering is especially unbearable when you know it's pointless.

It's often struck me that life is distributed unfairly. I just got back from visiting my grandmother's best friend in the hospital, who is on a ventilator and probably hasn't long to live. She certainly enjoys her life and finds meaning in it - how awful, then, that those of us for whom life is an unwanted burden cannot transfer it to those who have use for more of it.

TGGP, I suspect that a large number of people go through phases like that - particularly in adolescence (you're precocious). I wonder, though, whether it tends to make people less certain of the reality of value once they snap out of it, and hence more tolerant of ideas like mine, or (more likely) the experience of doubting the value of life calcifies their sense of value and makes them ever more sure that people like me are wrong, the way a period of religious doubting acts to harden religious faith.

Oddly, when I was a wee lass, I never doubted that life had meaning, because it seemed clear from inspection that the meaning of life was sex. This seemed so obvious that I couldn't figure out why people seemed to think the "meaning of life" thing was still an open question, especially given our knowledge of evolutionary biology.

In your review, you note that Joiner "implicates specific genes and brain traits in suicidality (even distinct from the genetic contribution to mental illness)." I did some Googling on this and the PubMed articles I found stop at around 2000, i.e., pre-Genome, pre-HapMap. Do you have any idea how things have panned out under more recent and sophisticated scrutiny? Nicholas Wade's recent NYT article on David B. Goldstein's work provides grounds for renewed skepticism. See:

One, I think Goldstein has a point - the widespread
diseases that impinge on reproduction
(schizophrenia) seem to be accounted for not by single genes, but by a bunch of possible breakdowns caused by mutation (I've heard the figure of 2,000 separate mutation pathways to get to schizophrenia).

My view is that suicide is not necessarily a (fitness-hindering) disease, like schizophrenia or childhood cancer, but rather that it's a potentially
adaptive
trait to be willing to commit suicide under certain circumstances. Given the complexity of this interaction, it would be ludicrous to expect a "suicide gene." There's not even that much genetic contribution to suicide, apparently - Joiner says children of suicides have about double the risk of suicide as the gen pop, which is not very much of an increased risk when your initial risk is measured in persons per 100,000. It could be that whatever heritable material (not just genes) is coding for the suicide trigger is shared by substantially all humans, rather than there being a genuine polymorphism somewhere.

Anyway - Joiner is writing in 2005, and he cites studies up to 2004, but, as you'd expect, none of them find any particularly compelling evidence for a "suicide gene" - just a statistically significant elevation in suicide attempts for this or that polymorphism of this or that gene, nothing dramatic.

Interesting. I arrived at the conclusion that depression must be some kind of behavioural strategy a few years ago, when I reflected on how being depressed had a paradoxical pleasurable tinge to it, a sort of comforting fog. I pondered why a survival machine would feel good about feeling like shit, and once I realized it was probably some leftover resource saving mechanism I stopped getting depressed, like a switch being flipped.

I still consider suicide on occasion, but from a far more clinical perspective. I think it was Martin Amis who said once you've seriously considered it once your mind keeps presenting it as a potential solution every time something goes wrong - kitchen flooded? Suicide!

I am very happy to have found this blog, and in particular appreciate the author's open-minded and objective thinking on suicide and the many issues around it.

When I was 19 I experienced a "nervous breakdown", in which I was preoccupied by suicide. It was as if the utter meaningless of life and the arbitrary and overwhelming cruelty of the world "broke through" some kind of veil and I was now seeing things as they were. And things as they were made me want to kill myself.

There followed several suicide attempts, a lot of medication, commitment to a psychiatric hospital, and ECT. Nothing helped.

I finally decided to deliver myself from the psychiatric establishment by feigning recovery from my illness. And so I have lived life, with all of my dyspepsia about it entirely intact.

And I can't say, now that I am old and gray, that it has been worthwhile to the extent that, had I known about the course of my life since 19 when I was 19, I would have felt any differently about wanting to kill myself.

People should be allowed to choose whether to live or not. And if they do not desire life, painless methods of death should be readily available.

I was struck by something I read (wish I knew the source) that our life is not ours to toss away. We're interdependent on others in ways we'll never appreciate. I don't think about this in any religious sense. I think that the impact on one's suicide on family and friends, in what legals call 'victim impact statement' terms, is horrendous. Perhaps in evolutionary terms this is not significant.But I heard of a teenage young man who's younger sister suicided, angrily say that she should have tried in with him their present. Face to face so to speak. And deal with impact on others.

Interesting. I think that would be especially fair if there were good options for living a decent life, and if parents somehow could be made aware of the ghastly consequences of their actions before they made their choice to create an innocent life.

Given that your twitter feed would indicate that you have found successful ways of palliating yourself, and that you might have other current readers (aside from this one), who are in the suicide-y or potentially suicide-y boat (and would therefore be selfishly disposing of lives that are not theirs to dispose of), it would be nice if you would share how you are doing and offer any help to us poor folk.

Hello, I'm a new reader and I wanted to say that I have really been enjoying your blog and that I second the above request for more about how you are getting by (and about the role of pleasure in life/your life in general).